FAQ for Diabetes Care Program| Dr Lal PathLabs
FAQ
  • Tell me about Diabetes

    What is diabetes and how does it happen?

    Diabetes Mellitus (DM) is a condition in which the amount of glucose in the blood is too high. This happens because the glucose is not well absorbed by body cells. Your body changes most of the food you eat into glucose. Your blood takes the glucose to the cells throughout your body. The glucose needs insulin to get into the cells of body. Insulin is a hormone made in the pancreas, an organ near the stomach. The pancreas releases insulin into the blood. Insulin helps the glucose from food get into body cells. If your body does not make enough insulin or the insulin does not work right, the glucose cannot get into the cells, so it stays in the blood. This makes your blood glucose level high, causing you to have diabetes.

    How does it happen?

    When you eat food, the body digests the carbohydrates, proteins and fats. (Anything it can't digest, like alcohol or fiber or toxins, either passes right on through or, if it makes it into the bloodstream, gets filtered by your liver). We measure these foods in grams and calories, but your body operates in terms of fuel. If you eat more food than your body needs - which most people do - the body is forced to store this excess.

    Bear in mind that every type of carbohydrate you eat is eventually converted to a simple form of sugar known as glucose, either directly in the gut or after a brief visit to the liver. The truth is, all the bread, pasta, cereal, potatoes, rice (stop me when you've had enough), fruit, dessert, candy, and sodas you eat and drink eventually wind up as glucose. While glucose is a fuel, it is actually quite toxic in excess amounts unless it is being burned inside your cells, so the body has evolved a way of getting it out of the bloodstream quickly and storing it in those cells. It does this by having the liver and the muscles store some of the excess glucose as glycogen. But here's the catch: once those cells are full, as they are almost all the time, the rest of the glucose is converted to fat. Saturated fat.

    Insulin was one of the first hormones to evolve in living things. It helps the body store extra nutrients for a bad day. Today when we eat too many carbohydrates, the pancreas pumps out insulin exactly as the genes tell it to (hooray pancreas!), but if the liver and muscle cells are already filled with glycogen, those cells start to become resistant to the call of insulin. Since the glucose can't get into the muscle or liver cells, it remains in the bloodstream. Now the pancreas senses there's still too much toxic glucose in the blood, so it frantically pumps out even more insulin, which causes the insulin receptors on the surface of those cells to become even more resistant, because excess insulin is also toxic! Eventually, the insulin helps the glucose finds it way into your fat cells, where it is stored as fat. Again - because it bears repeating - it's not fat that gets stored in your fat cells - it's sugar.

    Over time, as we continue to eat high carbohydrate diets and exercise less, the degree of insulin insensitivity increases. Unless we take dramatic steps to reduce carbohydrate intake and increase exercise, we develop several problems that only get worse over time.

    When your liver becomes insulin resistant, it can't convert thyroid hormone T4 into the T3, so you get those mysterious and stubborn "thyroid problems".

    But the good news is that there is a way to avoid all this. It's all right there in your genes. First off, exercise does have a major impact on improving insulin sensitivity since muscles burn your stored glycogen as fuel during and after your workout. Muscles that have been exercised desperately want that glucose inside. That's one reason exercise is so critical for type 2 diabetics in regaining insulin sensitivity. It's also the reason why endurance athletes can eat 400 or 600 grams of carbs a day and stay lean – they burn it all off and make room for more.

    Second, cutting back on carbohydrates, especially the obvious sugars and refined stuff is absolutely essential. Make fresh vegetables the main part of your meal. Not only should diabetics limit carbohydrate intake – everyone should. We are after all, in an evolutionary sense, predisposed to becoming diabetic.

    How do I know I have Diabetes?

    At the beginning there may not be any symptoms. When blood sugar is above 180 mg%, sugar starts appearing in the urine. Sugar in the urine drags water and you pass a lot of urine and feel dry and thirsty. You may also feel tired and lose weight. Your appetite increases and peculiarly you may notice that you are losing weight in spite of eating more. Some people complain of poor eyesight.

    Who are at risk of Diabetes?

    Following are risk factors that you can consider

    • Family history of Diabetes is the major risk factor.
    • Sedentary life-style, obesity
    • Smoking
    • Excessive alcohol intake
    • High blood pressure
    • In case of women previous diabetes in pregnancy or delivering big baby (birth weight more than 4Kg)

    Can I prevent Diabetes when my risk is high?

    If you have family history, you need to be extra careful. Things in your hands are healthy eating (i.e., eating vegetables and fruits, avoiding fast food), healthy life-style (regular exercise, avoidance of smoking, moderation of alcohol, etc) and keeping your weight in accordance to your height. Certain medicines are being used recently for preventing Diabetes in people who have borderline Diabetes.

    The following blood tests are used to diagnose diabetes

    • Fasting Plasma Glucose (FPG) > = 126 mg/dL
    • Oral Glucose Tolerance Test (OGTT) >= 200 mg/dL
    • Glycosylated hemoglobin or hemoglobin A1c >= 6.5%
    • Random Plasma Glucose Test >= 200 mg/dL

    Did you just get diagnosed with diabetes? It must have come as a shock!

    When you are diagnosed with diabetes, you may have a lot of feelings that come at once. Some people can't sleep, burst into tears, or worry a lot. These are all very normal responses.

    Other Common Reactions Are:

    • This cannot be happening – something is wrong in the tests
    • Questioning why this happened to me
    • Feelings of helplessness
    • Fears of making treatment mistakes or dying
    • Fears of future complications
    • Fears about how others will treat you

    How can you get over the shock?

    Learn as much about diabetes as possible. Most people don't know much at first, so this is not easy. "It's like taking a course at a time when you are in shock. But it is important

    Try to get support from family and friends to help you deal. Research shows that the more support you get, the better off you are. Finally, realise that you can live with diabetes and live a healthy life.

    Who Should See a Doctor?

    Everyone once diagnosed should see a doctor regularly. We can talk about what it is like to be diagnosed, the struggles you can expect, and how you are going to live with it.

    Do you see yourself as sick, victimized, dependent and pessimistic, or as normal, optimistic, independent and in control? How you define yourself in relation to your diabetes may make a dramatic difference in your emotional well-being and how well you take care of yourself.

    I have nobody in my whole family with Diabetes, how did I get it then?

    Family history certainly is an important factor, but the fact is being Asian, we all have high- risk gene for Diabetes. In India 4% of villagers and up to 15% of city dwellers have Diabetes. Not only do we have more Diabetes, we are getting it at an earlier age than people in the west (around 10 yrs). Diabetes can be due to your lifestyle choices (such as diet, smoking, alcohol or lack of exercise). The good news is that a good management of diabetes can go a long way in helping you lead a normal life. Diabetes is a disorder that can be lived with, provided its management is done well.

  • Diabetes Treatment

    How is Diabetes treated?

    Diabetes is best identified and treated by a qualified doctor. A good management equals good diabetes control and avoids future complications. Diabetes management in five Steps:

    • A healthy diet.
    • Regular Exercise.
    • Regular Monitoring of blood glucose levels.
    • Medications with oral anti diabetic medications and insulin, if needed.
    • Regular lab tests to evaluate health and avoid long term issues

    Have you set your goals for diabetes management?

    In order to manage diabetes well, it is important to know and set your goals right away. If you don't know your goals, just get in touch with your doctor and he should be able to guide you.

    We have guidelines from international societies and experts below. Talk to your doctor to get the right adjustment for you.

    Parameter
    Goal
    Recommended Guideline
    Home Blood glucose reading
    For Pre Meal or Fasting <130
    For Post Meal or Random <180
    Monitor your home blood glucose readings at least 4 times in a week and try to take readings at different times in the day
    HbA1c (average blood glucose reading measured in a laboratory)
    < 7%
    Test your HbA1c every 3- months
    Exercise
    Number of days per week and the number of minutes per day
    5or more days per week of 30-60 mins each day of brisk walking (or equivalent).
    It is important to consult your doctor before deciding on which exercise is best for you.
    Food
    What are the right number of calories for you in a day?
    Check with your doctor on what are the right calories for you. This would depend on your current weight and height.
    In general, if you need to lose weight, the doctor will slightly reduce your calories per day.
    Medicine
    What are the medications that you need to take?
    Here, the doctor is the best to recommend which medication you need to take. He will also look at how to modify the medicines later based on how your body responds, so record your blood sugar regularly along with food intake and exercise..
    Blood Pressure
    Less than 140/80
    Check your blood pressure reading once a week. A good blood pressure control is important to avoid future complications related to your heart.
    Weight
    What is your weight target in the next 3 months?
    If you are overweight, you would have a weight target to reduce your weight by around 10% in the next 3 to six months. If you are underweight, you may have to put on some kilos to be healthier.


    *As per American Diabetics Association (ADA) and Research Society for Study of Diabetes in India (RSSDI)

    Importance of Food in Treating Diabetes

    What I EAT is important to manage diabetes. Tell me more!

    There is good news. There is no special diabetes diet. Your diet should be based on the same principles of healthy eating that everyone should follow.

    Basic principles of a good diet:

    • Eat regular meals - Eat a well balanced diet at regular, frequent intervals (say, every four hours). This would allow your blood sugar levels to be better controlled. If you eat too much at one time, the blood sugar will go high. And if you don't eat for a long time, the blood sugar will go too low. Remember those shaadis that you have attended – if you measure blood sugar after eating a lot you will find that it can be too high. Regular eating will avoid that.
      Tip: If you are outside your house and you don't have regular food, carry some fruits/low calorie biscuits along with you.
    • Cut down on high sugar foods - Foods with sugar (sucrose or glucose) require little or no digestion for your body to absorb the sugars. This means they cause blood glucose to rise quickly after a meal.
      Normally the pancreas produces a boost of insulin to cope with the raised blood sugar, but in diabetes this process fails. So moderating the amount of high sugar foods in your diet will help control your blood sugar level.
    • Reduce the amount of fat - Compared to the other foods, fat has the most amount of calories - 9 calories per gram. This means cutting down the amount of fat you eat will have the most effect on reducing your total calorie count. When you use oil, use one that is high in 'good' fat such as olive oil and rice bran oil, but use it sparingly. Use a spray for oil that is now available in some markets. If you don't have a spray for oil, you could achieve the same effect by using a cloth for spreading oil. You can reduce fat by grilling, steaming or microwaving foods and buying lean cuts of meat - for example chicken breast without the skin. Low-fat choices are easy to find in supermarkets, but be careful of this label. Reduced fat crisps may be lower in fat than a standard bag, but they are by no means a low-fat food. Instead, you would be better off choosing a different type of snack altogether eg a piece of fruit.
    • Eat five portions of fruit and veg a day - Eating five portions of fruit and vegetables every day provides the essential vitamins and minerals we all need.
      To make sure we get a variety of nutrients and take advantage of the host of benefits they provide, it's important the fruits and vegetables are different types.
      A good intake of fruit and vegetables has also been proven to reduce blood pressure and protect against conditions such as heart disease - it may even prevent some cancers.
      Adding a glass of pure fruit juice to your daily diet is a simple way to get one of your five portions.
    • Reduce salt intake - Six grams of salt or less a day is the recommended amount for adults. This equates to a slightly heaped teaspoon. The problem is that even if you don't add salt to any of the food you eat, the amount of 'hidden' salt in processed and packaged foods means you can easily eat two to four times this daily limit. For example, a single slice of bread can contain 0.5g of salt.
      Common salt is sodium chloride. On food labels, the salt content is often given as grams of sodium. To convert sodium to grams of salt, multiply the quantity of sodium by 2.5. The daily limit is about 2.5g of sodium. Don't forget the amount stated on the label is often per 100g, not for the product itself. A standard ready meal weighs about 500g, so at 0.5g sodium per 100g it would contain 2.5g sodium – your total daily intake. Read labels on packaged food. You can reduce levels of salt in your diet by:

      • not adding salt to meals
      • limiting the amount used in cooking
      • choosing foods that contain 0.1g sodium or less per 100g – three quarters of the salt we eat comes from foods we buy
      • switching everyday foods to low-sodium/reduced salt options – this means breakfast cereal, soup, biscuits, tinned vegetables and ready meals
      • limiting salty foods such as crisps, cheese and pickles
      • using more herbs, spices and ground pepper.
    • Keep alcohol to moderate levels - Drinking up to two units of alcohol a day appears to have a beneficial effect on cardiovascular risk. It's thought that compounds within some alcoholic drinks, particularly red wine, mop up 'free radical' molecules that can cause tissue damage.
      But these benefits rapidly turn to negatives when higher levels of alcohol are consumed.
      In diabetes alcohol can also lower the blood glucose level. This makes a hypoglycaemic reaction more likely – as does drinking on an empty stomach.
      The recommended limits for alcohol consumption are: 14 units per week for women and 21 units per week for men. This should ideally be spread over the week.
      A unit of alcohol is:

      • 250ml (1/2 pint) of ordinary strength beer or lager
      • A 125ml glass of wine
      • A small measure for spirits (25ml)

    What is the right amount to eat?

    The amount of food you eat will affect the level of sugar in your blood. Eat small amounts of food. One easy way to eat less is to divide your plate into three parts. Half of the plate should contain vegetables. One-quarter of the plate should contain meat or protein, such as dal, fish, chicken, paneer, rajma etc. One quarter should contain a carbohydrate or starch, such as rice, corn, potato, or whole grain bread.

    How frequently should I eat?

    The timing of your meals can affect the level of sugar in your blood. If you wait too long to eat, your sugar level can be too low.

    If you eat meals too close together, or snack throughout the day, your sugar level can be too high.

    It is important to eat after taking your medicine or insulin to make sure your sugar level does not fall too low. Do not skipmeals.

    How can I make sure I have a good diet?

    • If you have diabetes, you should have access to a qualified dietician through your doctor.
    • Your dietician will help you work out your daily calorie needs, taking into account your age, lifestyle, work and activity levels.
    • Your dietician will identify any problems with your diet and is there to help if you're having difficulties.
    • Most of all, your dietician will help you understand the relationship between what you eat and what you need – once you understand this, the diet aspect of diabetes will fall into place.
    • You can keep a track of your food habits at Druid Diabetes Management.

    Can I manage Diabetes with Diet only?

    Diet is a very important aspect in the treatment of Diabetes. At the beginning you may be successful in controlling Diabetes with diet only, but in order to maintain the right weight and body functions, you should initiate exercise. You may need medication as well to better manage Diabetes. The timing to take medication is different for different people, for somebody this can be a few months while for others it may be a few years. Get in touch with a doctor to get the right advice.

    Exercise and Diabetes

    How does exercise help in diabetes?

    Exercise offers golden advantages to diabetics. It:

    • Lowers blood glucose levels quickly
    • Improves the body's ability to use insulin
    • Reduces insulin requirement
    • Reduces risk of heart disease
    • And overall, offers (much) better control of diabetes!

    Try and convience those around you to join you in exercise. If they start exercising, they dramatically reduce their chances of getting diabetes. If they do already have diabetes and join you, they will have the same benefits as you do!

  • How does exercise help in diabetes?

    There are a few things to keep in mind before we start out exercising when we have diabetes. Because your body may be more fragile than before, it makes sense to treat it well from the beginning. Once you have started out on the right track, you can build up speed and energy along the way as you feel comfortable.

    • Get your doctor's clearance This is to be sure that our exercise is right for us. We may have to be extra careful in certain situations and our doctor is the right person to tell us so.
    • Walk before you run Build up your body strength gradually. It is more important at every stage to be regular for 30-45 mins daily. Your real challenge in the beginning is to talk to 'the voice in your head' that tells you to 'relax' or 'not today', and get some exercise for a brief time everyday.
    • Wear the right footwear Consult with an expert when you buy the shoes. Make sure that they fit well and are appropriate for running.
    • Dress appropriately Wear light, comfortable clothing
    • Find a partner or role model Look in your family or society for people that go out regularly. You will probably find them if you yourself become regular. It will start with 'hi' and 'hello' and then you will find that you are making friends for exercise.
    • Ignore the voice in your head that says 'don't go today' Being regular is easy if you ignore that voice. Being regular is difficult if you start to listen to that voice. And trust me – all of us have that voice that tells us to take it easy, even that fit couple that lives in your society. They choose to ignore it.
    • Have a planfor managing your diabetes Diabetes makes you special and gives you special needs. Measure your blood sugar before and after the activity. Carry juice, a sports drink, a piece of fruit or glucose tablets. Keep a training log on My Health and record your progress.
    • Listen to your body Starting gradually and being consistent are the secrets to improving your health and fitness, avoiding injury and managing your blood sugar levels. You body will tell you how much . If you can walk and talk without feeling breathless you may step up the speed. Once you feel you cannot talk, then slowdown.

    Can I exercise at home?

    For many people with diabetes, exercise means heading out to a health club or walking around the neighborhood. People do not have time to go outdoors for exercise due to pressures of household work, looking after children, ailing parents etc. But indoor exercise at home can be just as effective for controlling diabetes. Here are some of the good ones

    • Housework: Active housework -- vacuuming, dusting, mopping, doing the laundry -- provides benefits similar to those of structured exercise. Playing fast-paced music helps increase movement.
    • Exercise videos: Exercising alone without external encouragement can be difficult. Exercise videos teach new moves in a focused 20- to 30-minute session, with guided warm-up and cool-down sessions. It's usually not hard to clear out enough space for a workout in front of the TV. Alternating workouts can help prevent boredom. DO consult your Doctor.
    • Make your own home gym at no cost: There are many kinds of workouts to do indoors: strength training with dumbbells (or water filled 1litre pepsi bottle or bricks); calisthenics, such as push-ups, crunches, and lunges, dancing and walking up and down stairs. Other choices are jumping rope, and dancing, as well as walking up and down stairs. If possible buy a stationary cycle, cycle while watching your favourite serial. Try not to use the cycle to hang clothes.
    • Strapping on a pedometer: This small step-counter that attaches to the belt helps track the number of steps taken during the usual household rounds. Daily totals should be monitored. Ten thousand steps per day is considered a healthy goal.

    Are there special precautions to be taken while exercising?

    There are some exercise precautions which people with diabetes must take, however, when done safely, exercise is a valuable aid to optimal health.

    Exercise precautions are designed to help people with diabetes avoid problems which can result from unwise exercise choices.

    Hypoglycemia can occur if a person who is taking blood sugar lowering medication has:

    • Eaten too little carbohydrate (fruit, milk, starch) relative to the exercise.
    • Taken too much medication relative to the exercise
    • Combined effect of food and medication imbalances relative to the exercise

    Those who do not take diabetes medication do not need to take these precautions. Drink plenty of water before, during and after exercise to stay well-hydrated.

    Are there special precautions to be taken while exercising if I am taking medication or insulin?

    Precautions to take if you take insulin or oral diabetes medication:

    • If your blood sugar level is less than 100 mg/dl prior to exercise, take a carbohydrate snack prior to beginning the exercise.
    • If your blood sugar level is higher than 100 mg/dl before exercise, it may not be necessary to take a carbohydrate snack before a light exercise session, but you may need extra carbohydrates during or following the exercise. Check your blood to see if your blood sugar dips below 70 mg/dl following exercise.
    • If you experience hypoglycemia, see 'What to do in case of Low Blood Sugar' and follow up with your doctor. You may be advised to lower your medication on days you exercise if your blood sugar levels are well-controlled and usually within target range.
    • For long duration and/or high intensity exercise sessions, plan extra carbohydrate snacks during the activity. Additional carbohydrates is suggested each 30 to 60 minutes of exercise (e.g. soccer game, hiking, biking, skating, etc).
    • Always carry a fast-acting carbohydrate food such as glucose drinks when exercising in the event blood sugar drops too low and hypoglycemia symptoms develop during exercise.
    • Wear a form of ID, which identifies you as having diabetes, particularly if you are exercising alone so that others may help you appropriately in the event something unexpected happens.
    Importance of Blood Sugar Monitoring

    Why is monitoring my blood sugar important?

    If you have diabetes, self-testing your blood sugar (blood glucose) is an important tool in your hands managing your treatment plan and preventing long-term complications of diabetes. Blood sugar tests are performed with a portable electronic device that measures sugar levels in a small drop of your blood.

    Why is monitoring my blood sugar important?

    Blood glucose monitoring is a wonderful tool that will allow you to learn more about your diabetes and your body.

    Blood glucose values are like pieces to a puzzle. The more pieces of the puzzle you have, the clearer the big picture will be.

    Blood glucose monitoring provides data for you and your healthcare team to:

    • Identify trends in glucose control
    • Identify factors that may cause high or low glucose values
    • Evaluate the impact of food, activity or medications on your diabetes
    • Identify where changes in the treatment plan are needed
    • Decide what you need to do when you are sick
    • Confirm whether or not the feelings you have are the result of a low or high blood glucose, or if it is something unrelated to your diabetes.

    When to check your blood glucose?

    Check your blood glucose atleast 4 times a week. Check at different times of the day to get an idea of how well your treatment program is working for you.

    The best times to check are before breakfast, before lunch, before dinner, and at bedtime snack. Sometimes it is helpful to check blood glucose 1-2 hours after a meal to see the effect of food on your glucose levels, and sometimes it is helpful to check in the middle of the night.

    When to increase the frequency of blood glucose checks?

    There are times when you will want to check your blood glucose more often than usual. You may think of other times as well.

    • During periods of stress, illness, or surgery
    • When you are pregnant
    • When low blood glucose is suspected or when you are having low or high blood glucose symptoms
    • When there are changes made in your treatment program — such as a change in medication doses, meal plan or activity
    • When taking new medications, like steroids
  • Tips on getting a good drop of blood

    Before sticking your finger:

    • Wash your hands with warm water.
    • Shake your hands below your waist.
    • Squeeze or milk your finger a few times.

    Keep a log book or register with Druid Health to record your readings

    Keep a record of your blood glucose values in a log book.

    • Note down your readings.
    • Write down your medication dose, especially any changes in your medication.
    • In the note or comment section, write down changes in food, activity, illness, stress, or insulin reactions.
    • Bring your log book to all your appointments with your doctor.

    Six steps to using glucose monitoring as a TOOL

    • Know your target blood glucose range.
    • Learn how to check your glucose.
    • Decide when to check your glucose levels.
    • Identify glucose patterns.
    • Determine what causes blood glucose changes.
    • Decide what to do to get your blood glucose levels back on target.
    Is your Blood Sugar High/Low?

    What are the signs of too much sugar or too little sugar in my body?

    High Blood Glucose Symptoms (Hyperglycaemia)
    High Blood Glucose Causes
    Low Blood Glucose Symptoms (Hypoglycaemia)
    Low Blood Glucose Causes
    Thirst
    Too much food
    Shakiness
    Too little food
    Hunger
    Too little exercise
    Sweaty
    Too much medicine
    Frequent urination
    Too little medicine
    Hunger
    More activity than usual
    Fatigue
    Stress
    Anxiety
    Too long between meals or snacks
    Nausea
    Illness
    Nervousness
     
    Blurred vision
    Injury
    Confusion
    Alcohol
    Headache
    Short time between meals and snacks
    Acting angry or irritable
     
    Nervousness
    Confusion
     
    Slurred speech, Headache, Tingling around lips, Numbness of feet and hands
     

    What should I do if I notice my blood sugar going low?

    If your blood sugar is below 90, you have to try and bring it back up. If it reaches below 70, you are in hypoglycaemia and you would start to lose concentration and ability to take care of yourself. It is also very useful to let your loved ones or friends know what are the signs and symptoms that they should look out for so they can help you in the right way.

    For low blood sugar, you could take the following foods that will help bring your sugar back up.


    Food Item
    Amount
    Orange or apple juice
    1/2 cup
    Grape or cranberry juice
    1/3 cup
    Soft drink with sugar
    1/2 cup
    Honey
    1 tablespoon
    Sugar packets
    4
    Toffees
    3-4
    Raisins
    7-8 pieces
    Glucose
    3-4 tablespoons
    Skim or low fat milk
    1 cup


    Within 15 minutes of treatment, you should feel better. Test your glucose. If it is still less than 70, or you don't feel better, take another snack. If the blood glucose level does not improve after this, call the doctor.

    Important Tests to Manage Diabetes

    How can I avoid future complications with diabetes?

    Even before you notice symptoms, high blood sugar can damage parts of your body. That's why certain diabetes tests to check blood sugar control and to catch problems early are so crucial.

    But many patients aren't getting key diabetes tests at least annually, such as thehemoglobin A1c test, a dilated eye exam, and a foot exam.

    A lot of us don't realise that regular tests can help us avoid future complications in diabetes.

    "People with diabetes should know that complications can be avoided," an American doctor says. "Unfortunately, we still see a lot of complications, and a lot of those could have been prevented. It's absolutely essential to get into this preventive mode as soon as possible. It definitely pays in the future."

    Don't miss these diabetes tests.

    Diabetes Test #1: Hemoglobin A1c

    This diabetes blood test, also called HbA1c, tells you and your doctor how well diabetes is managed over time. It measures your average blood sugar in the previous three months to see if it has stayed within a target range.

    Here's how this test works. Your red blood cells contain hemoglobin, which allows cells to transport oxygen to tissues. As a cell ages, the hemoglobin becomes increasingly "glycated," meaning that more glucose molecules stick to it. Higher glucose levels in the blood mean higher glycated hemoglobin, which translates into a greater HbA1c reading.

    • Normal HbA1c is 5% or less.
    • An HbA1c value above 7% means diabetes is poorly controlled.
    • People with diabetes should aim for an HbA1c value below 7%.
    • You don't need to fast or prepare for an HbA1c test. Ask your doctor how often you need to be tested. Doctors usually recommend every 3 to 6 months.
    • Keeping blood sugar under control has been proven to reduce risk of complications!

    Diabetes Test #2: Eye Exam

    If you have diabetes, your ophthalmologist should perform an eye exam

    With diabetes, high blood sugar can affect tiny blood vessels in the retina, the light-sensitive tissue at the back of your eye. Without treatment, the blood vessels can bleed, blur vision, severely damage the retina, and lead to vision impairment or blindness.

    The good news: when doctors detect diabetic retinopathy, they can help prevent vision loss with timely and highly effective treatments. "Prevention is absolutely the key. If the patient waits until the vision is gone, it's probably not going to be restored to normal," a doctor says.

    All people with type 1 or type 2 diabetes should have an eye exam at least once a year as part of a complete eye exam. Early retinopathy may cause no noticeable symptoms, so regular eye exams are crucial for detecting emerging problems.

    "A lot of patients tell me, 'I see fine. Why should I go and see the eye doctor?'" A doctor says. "I tell them, 'That's exactly the time to go see the eye doctor because you can keep your vision great.'"

  • Diabetes Test #3: Foot Exam

    Diabetes can cause nerve damage and numbness, as well as decreased circulation that makes it harder for your body to fight infection. Patients with numbness problems may not notice if they injure a foot. A resulting infection may not heal well, and skin and other tissue may die. In a small minority of cases, the problem progresses into a complication that requires amputation.

    Remove your socks and shoes each time you visit your doctor as a reminder for him or her to check your feet for sores and infections. Once or twice a year, your doctor should do a more thorough foot exam. Ask him or her to make sure your foot nerves and blood circulation are all right.

    Between doctor's visits, follow a daily routine of caring for your feet and inspecting them. Carefully check the top and bottom of your feet and between your toes. Look for sores or ulcers, breaks in the skin, blisters, redness that suggests an infection, ingrown toenails, or any other changes that worry you. Report any problems to your doctor right away. Other preventive tips:

    • Protect your feet with comfortable shoes that fit well. Before you put on shoes, always check to make sure there are no pebbles or other objects inside.
    • Test water temperature before you put your feet in to prevent burns.
    • Wash your feet daily with soap and water and dry them thoroughly to help prevent infection.
    • After bathing, moisturize dry skin on your feet with lotion, petroleum jelly, lanolin, or oil to prevent skin from cracking, which can lead to infection. Don't put lotion between your toes.
    • Ask your doctor to show you how to trim toenails. Soak your feet in lukewarm water to soften nails and trim them straight across to avoid ingrown toenails.
    • If you have corns or calluses, have them checked and removed by a podiatrist, a health care professional who specializes in managing foot diseases.
    • Exercise regularly and avoid smoking to promote good circulation.
    • Don't walk around barefoot.

    Diabetes Test #4: Blood lipids tests.

    This test checks your LDL (bad cholesterol) and HDL (good cholesterol) and triglyceride levels. Lipid profile screening should be done at least once a year.

    Diabetes Test #5: Kidney function tests.

    Get an annual urine test to check for the presence of protein, as well as a blood test at least once a year to check for creatinine. These tests indicate how well your kidneys are working.

    Diabetes Test #6: Blood pressure check.

    Have blood pressure checked at every medical appointment. Better still, check it at home once a week. The goal for people with diabetes is less than 140/90 if they have no complications from the disease. If complications are present, the goal is lower. You can check with your doctor.

    Diabetes Test #7: Liver Function Test

    Get an annual liver function test done. The liver is important to make sure that the right medications can be given and they work for you.

    Diabetes Test #8: Urine Examination

    Get an annual urine exam to rule out infections, to see the condition of your kidney function and check how much sugar is passing through the urine.

    More Questions that you may need Answer for

    Is there any job restriction for people with Diabetes?

    Diabetes should not be a selecting or refusing factor in employment arena. We need to make this clear to employers and employees. Driving is a problem if you are getting frequent low blood sugar, and as a rule people with Diabetes on Insulin are not given license to drive heavy vehicle and buses. Make sure that people around you know that you have Diabetes. Tell them about it and what they should do in case you have a severe low blood sugar symptoms.

    What is Gestational Diabetes Mellitus (GDM)?

    Gestational diabetes occurs during pregnancy. During pregnancy your body makes hormones that keep insulin from doing its job. To make up for this, your body makes extra insulin. But in some women this extra insulin is not enough, so they get gestational diabetes. Gestational diabetes usually goes away when the pregnancy is over. Women who have had gestational diabetes are very likely to develop type 2 diabetes later in life.

  • How is sexual activity affected in diabetes mellitus?

    Diabetes mellitus of both types 1 and 2 affect sexual performance in both males and females, though the effect is observed very obviously in the males. Males suffering from diabetes may develop impotence after a length of time. However, this complication can be avoided by good management of diabetes. Better control is the key!

    What precautions must be taken for a diabetic patient who has to undergo an operation?

    Operations can be done with diabetes, provided some precautions are taken. Blood sugar should be brought down to normal before the surgery. For this reason, insulin injections are given to the patient during and after the operation. Wounds may take longer to heal than normal patients. Due to the patient's weak immune system, they may take longer time to come out of the anesthesia. That is why, it is necessary to reveal to the surgeon about the presence of diabetes mellitus before gearing up for a major operation.

    Can diabetic patients travel for long distances? What are the precautions to be taken?

    If the patient is suffering from diabetes mellitus type 1, then it is necessary that they take added calories. This is to meet the requirement of the body during travelling. For people suffering from diabetes mellitus type 2, they must ask their doctor about the precautions. This would depend on the severity of their condition and how long they are suffering from.

    Travel Tips

    • Carry an ID that says you have diabetes.
    • Learn how to say "I have diabetes" and "sugar" or "orange juice" in the languages of foreign countries you plan to visit.
    • Take extra diabetes medications and supplies you need in case you need to stay longer or have travel problems.
    • Pack your medicine and supplies in your carry on luggage. This includes all pills, your glucometer and supplies, insulin (if you take it) and snacks.

    Other general travel tips:

    • Do not use insulin from another county. It may be different that what you use here.
    • Continue to check your blood sugar regularly

    Relax and enjoy your travels. With your preparation, you can leave the worries behind and have a great time!

    What kinds of medicines must not be used by me?

    You need to be careful while taking any medicine that causes a hormonal imbalance. Hence, all steroids, corticosteroids, antidepressants, antibiotics, antihistamines and immuno-suppressants must be taken with care. Medicines like cough syrups, diuretics, painkillers and the medicines used for the treatment of high blood pressure must also be checked with the doctor as they can increase the content of sugar in the blood. Before taking any medication, it is necessary to get a prescription to a doctor, and let the doctor know you have diabetes.

    Diabetes and Your Mood

    Your mood can affect what you feel like doing and how you take care of yourself. If you feel upset or frustrated because you have diabetes, you might not want to exercise or eat right. However, exercising can help your mood and make you feel better. Eating right can help you feel in control of your diabetes.

    Sometimes it might be hard to tell your friends and family that you cannot eat certain foods. It is important to be honest with them about what you can eat and ask for their support. Bringing a friend on a walk can help lift your spirits and keep you healthy!

    If you are in a bad mood all of the time, you should talk to your healthcare provider about your feelings. Reaching out to your doctor can be helpful. Having diabetes does not mean you will be sick for the rest of your life. It means that you need to make adjustments to take care of yourself to stay healthy. Know that diabetes is something that can be lived with and for some of the people that we have interacted with, they have a great sense of achievement by managing it well. Above all, we want you to know that you are not alone.

    Can I have drink when I have Diabetes?

    Yes, you can. Alcohol is not banned in people with Diabetes. A little alcohol is fine but a lot is not, regardless of whether you have Diabetes or not.

    Just remember "Hypo" (low blood sugar) can occur with alcohol and you should not skip meal after a drink with the fear of calorie in the drink.

    You need to know the medically allowed limit of alcohol. The limit for men is 21 units and for women 14 units a week. A small measure of Whisky, Rum, Vodka or Gin, a small glass of Beer or Wine is measured as one unit. It is better to space that rather than taking weekly quota on a day!

    Sweet wine or Sherry should be avoided if possible, as they have very high sugar content.

    Can I have ice cream? Can I take artificial sweetener?

    Occasionally yes, but do not make a habit of eating ice cream regularly. There are certain ice cream available now with no added sugar, but do not forget they have calories. As for artificial sweeteners, certainly yes, artificial sweeteners are safe. Do not put them in cooking - they break down when heated and they will not be sweet any more.

  • Do you know everything there is to know on how to use Insulin?

    What is insulin?

    Insulin is a natural hormone made by the pancreas that controls the level of the sugar glucose in the blood. Insulin allows the cells to use glucose for energy. Cells cannot utilize glucose without insulin

    In diabetes either pancreas don't make insulin at all or cannot utilise it properly

    Insulin prevents the long-term complications of diabetes, including damage to the blood vessels, eyes, kidneys, and nerves.

    How do I inject insulin?

    1. Get all your Supplies: Insulin (Verify) Syringe Alcohol wipe Disposable gloves Sharps Container
    2. Wash Hands and roll the insulin vial between your palms.
    3. Clean insulin Vial and let it dry
    4. Pull the plunger down to number of units to be taken
    5. Inject Air into the insulin bottle
    6. Draw out the number of units of insulin:
    7. Select the injection site Abdomen Thighs Outer arms
    8.Pinch your skin and inject needle into skin at 90°
    9. Push the plunger inside
    10. Release the pinch and then take out the needle.
    11.Dispose of the syringe into sharps container.
    12. Record time, dosage and blood glucose value
    13. Have your food.
     

    What are the areas to avoid when injecting insulin?

    • Near moles
    • Near scars
    • Areas that looked inflamed, infected, or have a rash
    • Within 3 inches of the naval (all the way around)
    • The same spot
    • Use one site at one time of the day, keeping every injection 1 inch apart

    How do I store insulin?

    • If stored in a refrigerator, unopened bottles are good until the expiry date printed on the bottle.
    • Opened bottles that are stored in a refrigerator should be used within one month of being opened.
    • With insulin pens and their cartridges, storage life ranges from seven days to one month.
    • Never store insulin in freezer or direct sunlight.

    What are right ways (and wrong ways) of using insulin?

    • Don't massage the site after insulin injection
    • Syringes used for injection should be compatible with the strength of insulin used.
    • Always inject into the subcutaneous tissue by pinching an inch of skin. Injections into muscle are absorbed faster and should be avoided.
    • Swabbing with alcohol is not necessary before injection as long as skin is clean.
    • Cap the needle after use.
    • Change the needle after 3-4 times of use.
    • While sharing in life is good, sharing of needles is not. Don't share needles.